Abstract
Background: Myasthenia gravis (MG) is an autoimmune disease which can
affect reproductive-aged women and impact pregnancy outcomes.
Objectives: To systematically review pregnancy outcomes for patients
with MG. Search Strategy: Ovid MEDLINE, EMBASE, Cochrane Central
Register of Controlled Trials, PubMed (Non-Medline records), Web of
Science, and LILACS databases were systematically searched for
pregnancies complicated by MG. Selection Criteria: Human studies of five
or more subjects reporting outcomes of MG in pregnancy published in any
language. Data Collection and Analysis: Following identification and
review of relevant studies, data on study characteristics, MG subtypes,
treatment, disease and pregnancy outcomes were extracted. Assessment of
bias was performed using the National Institutes of Health Quality
Assessment Tool for Case Series. In addition, cases of MG in pregnancy
managed at our centre were identified and outcomes included in the
analysis. Main Results: In total, 32 publications met inclusion criteria
for systematic review, for a total of 33 unique data sets including 48
cases at our institution. In total, outcome data was available for 824
pregnancies complicated by MG. Overall risk of MG exacerbation was
33.8% with a 6.4% risk of myasthenic crisis in pregnancy and 8.2%
postpartum. Spontaneous vaginal delivery occurred in 56.3% of
pregnancies. The risk of transient neonatal myasthenia gravis (TNMG) was
13.0%. Conclusions: One third of pregnant MG patients will experience
an exacerbation with 6.4% and 8.2% experiencing myasthenic crisis in
pregnancy and postpartum respectively. More than half of MG patients had
a spontaneous vaginal birth. The risk of TNMG is 13%